Approach to postmenopausal bleeding Quiz: Ace Your Exams

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A 58-year-old woman presents to the emergency department with acute heavy vaginal bleeding. She has had occasional light post-coital spotting over the past 6 months. Today, after intercourse, she developed heavy bleeding and has soaked through 4 pads in the past 2 hours. Her last menstrual period was 6 years ago, and her last cervical cancer screening was negative 10 years ago. Past medical history is notable for two prior abnormal pap smears in her 30s that resolved spontaneously without treatment. She takes no medication. Temperature is 36.5°C (97.7°F), pulse is 112/min, respirations are 22/min, and blood pressure is 92/56 mmHg. A pelvic exam shows a large friable cervical mass extending to the vaginal wall that is actively bleeding. An IV is placed, fluids are given, and the gynecologic surgeon is emergently consulted. What is the most appropriate next step in management?

Elimination tool

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Pack the vagina with hemostatic gauze

Continue IV fluids and await recommendations from the gynecologic surgeon

Start IV estrogen

Perform loop electrosurgical excision procedure (LEEP)

Transfer to the operating room for emergency hysterectomy